Emergency Department Boarding and Crowding

Patients "boarding" in the emergency department (ED), or placed in a holding pattern while waiting for care or transfer, are overwhelming emergency physicians, care teams and staff who do all they can to treat or stabilize every patient that needs care.

While the causes of boarding are multifaceted, staffing shortages and the resulting burnout only exacerbate the crisis and perpetuate a dangerous and sometimes deadly cycle. To help address this crisis, ACEP President Christopher S. Kang, MD, FACEP is currently forming a task force to develop clinical recommendations as well.

Advocacy

ACEP has been leading national efforts to address ED crowding and boarding for several decades. Currently we are advocating directly with the White House, bipartisan members of Congress, regulatory agencies, and other stakeholders involved in constructive approaches to alleviate the factors that lead to our nation’s boarding crisis.

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Research

1. To Reduce Emergency Department Boarding and Hospital Crowding, Look Beyond the ED (ACEP Now, November 13, 2016)
2. Tips for Managing Heavy Workloads in the Emergency Department (ACEP Now, September 29, 2017)
3. Early Hospital Discharge Can Improve Capacity, Patient Flow (ACEP Now, December 11, 2016)
4. Patient flow through the emergency department (R³ Report | Requirement, Rationale, Reference, The Joint Commission, Issue 4, December 19, 2012)
5. Association between boarding in the emergency department and in-hospital mortality: a systematic review (PLOS One, April 15, 2020 https://doi.org/10.1371/journal.pone.0231253) 
6. Emergency Department Crowding: The Canary in the Health Care System (NEJM Catalyst, September 28, 2021)
7. Boarding Critically Ill Patients in the ED (Journal of the American College of Emergency Physicians Open, July 17, 2020 | DOI:  https://doi.org/10.1002/emp2.12107)
8. Evolving Models in Caring for ICU Boarders (Annals of Emergency Medicine, July 08, 2020, DOI: https://doi.org/10.1016/j.annemergmed.2020.05.007)  
9. US Performance on ED Throughput (2006-2016) (Annals of Emergency Medicine, April 14, 2021  DOI: https://doi.org/10.1016/j.annemergmed.2021.01.009) 
10. Critical Care Delivery Solutions in the Emergency Department: Evolving Models in Caring for ICU Boarders (Annals of Emergency Medicine, July 08, 2020 DOI: https://doi.org/10.1016/j.annemergmed.2020.05.007)
11. The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Boarding and And Crowding (Annals of Emergency Medicine, January 23, 2020 DOI: https://doi.org/10.1016/j.annemergmed.2019.12.002)
12. High Impact Solutions Report (American College of Emergency Physicians, Emergency Medicine Practice Committee, May 2016)